AccountId: 011433970860
ContactId: 1c88da08-7fa7-44f1-a8c9-5a25baeaabe6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 426029 ms
Total Talk Time (AGENT): 182160 ms
Total Talk Time (CUSTOMER): 159841 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/1c88da08-7fa7-44f1-a8c9-5a25baeaabe6_20250328T16:42_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. My initial last is [PII], and I'm calling from provider's office to get the benefits for a member.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, I'm so sorry. What was your first name?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII]. OK, thank you. And [PII], you said that you're needing to get
[AGENT][NEUTRAL] Eligibility on a member?
[AGENT][NEUTRAL] Or claim status.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Eligibility
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] Yes, ma'am. I can help you with that, [PII]. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] Thank you. And the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Yeah, sure. The member's policy number is
[CUSTOMER][NEUTRAL] 024
[CUSTOMER][NEUTRAL] 534
[CUSTOMER][NEUTRAL] 57 M Mary, L Lima 8.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It out.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] OK. The patient name is?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh yeah
[AGENT][NEUTRAL] OK, so I do show that she is the subscriber on the supplemental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] A
[AGENT][NEUTRAL] And if you all will be filing a claim.
[CUSTOMER][NEUTRAL] And there's the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you're going to be filing a claim, yes ma'am, with APL for this member on this policy, we will also need for you to send us a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Go ahead, please.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal, Olivia that you should be able to check claim status in and our portal website is located at [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. And there's the uh secondary insurance, like, uh, this insurance is covered as a secondary, right?
[AGENT][NEUTRAL] Yes, ma'am, we are not a major medical insurance. This is a supplemental policy to our primary insurance.
[CUSTOMER][NEUTRAL] OK. And I just wanna know that does the uh insurance uh will be covered, the primary insurance deductible and co-insurance or not?
[AGENT][NEUTRAL] I covered services. Are you also needing benefit information?
[CUSTOMER][NEUTRAL] Yes, I just wanna know that like the uh like the deductible of family insurance and co-insurance will be covered by secondary or not?
[AGENT][NEUTRAL] Again, I cannot guarantee payment. This policy is designed to help with co-pays, deductibles and co-insurance amounts of coverage services. Are you needing benefit information for inpatient, outpatient, or office?
[CUSTOMER][NEUTRAL] For outpatient.
[AGENT][NEUTRAL] OK, the outpatient benefit maximum on this policy?
[AGENT][NEUTRAL] Per calendar day for covered outpatient services is $500 and there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] $500?
[AGENT][NEUTRAL] That is the benefit maximum per calendar day for covered outpatients mhm for covered outpatient services.
[CUSTOMER][NEUTRAL] Co-pay.
[CUSTOMER][NEUTRAL] OK, benefit, ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Per day, right?
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] It is for, it is for the uh uh calendar year or for the birthday?
[AGENT][NEUTRAL] No, ma'am, per calendar day.
[CUSTOMER][NEUTRAL] OK, per calendar day. OK, thank you. And what's the member, OK, ma'am what plant type is supplemental, right?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And what's the full plan name?
[AGENT][NEUTRAL] Medblink.
[CUSTOMER][NEUTRAL] Can you please spell out this?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. Medlink and
[AGENT][NEUTRAL] That is the name of the supplemental plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for giving that information.
[AGENT][POSITIVE] You're welcome. And is there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Can you please spell out your name for me?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And my name and today's date will be your call reference number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. I have one more question regarding this.
[CUSTOMER][NEUTRAL] Like, uh, if the member is taking CT scan service.
[CUSTOMER][NEUTRAL] OK, today, then, if the primary is covered the, and if the primary insurance has the deductible.
[CUSTOMER][NEUTRAL] Then, uh, and it will be remaining, then, uh, the secondary insurance will be covered uh to that amount or not?
[AGENT][NEUTRAL] Again, I cannot guarantee payment. I can only provide you the benefit information on the policy.
[AGENT][NEUTRAL] We will have to receive the claim along with the primary insurance company's explanation of benefits for review.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for giving me that information and I hope for the day and have a great day. Bye-bye for now.
[AGENT][POSITIVE] OK. Well, I hope you have a great day as well, and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye for now.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh. Bye-bye.
[CUSTOMER][NEUTRAL] OK.